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An estimated 8 million Americans are not using their preferred contraceptive method, and discrimination and lack of person-centered counseling have contributed.
An estimated 8.1 million people in the United States are not using their preferred birth control method, and discrimination and person-centered counseling are significant contributing factors, according to a survey published in The Lancet Regional Health – Americas.
“Contraceptive use is a preference-sensitive decision, as most people have multiple medically appropriate options, yet policy conversations regarding contraceptive access often fail to center the extremely personal nature of contraceptive decision-making and instead focus on increasing access to and use of specific methods,” Anu Manchikanti Gómez, PhD, MSc, and colleagues wrote.
The authors added that conventional metrics on birth control access typically presume populations are cisgender women and do not account for people who use contraceptives for reasons other than preventing pregnancy.
To address these gaps, the researchers designed their study in three parts. First, the authors interviewed 36 people in the healthcare, research, and reproductive justice sectors. Then, the researchers used the interview findings and existing data to create a new survey to quantify key aspects of person-centered birth control access. Lastly, a working group examined the survey and identified priority metrics.
“This paper reports data from the national survey phase of the project, with a focus on one priority metric identified by the working group: use of the preferred contraceptive method,” Dr. Gómez and colleagues said.
The Data on Contraceptive Use
Using a nationally representative sample in the NORC’s AmeriSpeak Panel, the researchers collected English and Spanish survey responses from January 13, 2022, to March 14, 2022.
There were 3,059 total respondents; of these, the final sample included 2,119 current and not currently pregnant or trying to become pregnant prospective contraceptive users. The sample represented about 32.4 million people in the United States.
Most respondents were women (96.9%) and heterosexual (80.5%), though participants reported various gender identities and sexualities. In addition, 54.9% of respondents were White only, 22.2% were Latino/Hispanic, and 12,7% were Black only.
To understand person-centered access, the survey included two measures assessing self-efficacy and two assessing the interpersonal quality of past contraceptive care.
“Per the person-centered healthcare access framework, the ability to realize one’s contraceptive preferences represents a successful outcome in the cumulative process of navigating contraceptive access (from information seeking to contraceptive use). The numerator of this measure captures a desire to maintain the use of a current method(s)—that is, respondents do not prefer to use a different method and do not desire to stop using their current method(s),” the researchers explained.
Gaps in Person-Centered Access
Most respondents (77.9%) felt they had sufficient information to make informed decisions about contraceptive use. Findings showed that 56.4% of respondents felt very confident about obtaining their preferred contraceptive when they wanted it, while 38.4% felt somewhat confident.
Less than half of respondents (44.5%) had never experienced discrimination in family planning settings. Only 35.1% of respondents had received person-centered counseling on birth control the last time they discussed their options with a clinician.
Among people who are currently or prospectively contraceptive users, findings showed that:
- 3% (95% CI 56.3-62.2) used a preferred method.
- 2% (95% CI 22.6-27.9) did not use a preferred method.
- 6% (95% CI 13.7-17.7) were uncertain.
About one-third of people not using a preferred method were not currently using contraceptives at all.
Those who did not use their preferred method reported concerns about side effects (28.8%), potential impacts on sex (25.1%), logistics and knowledge barriers (18.6%), safety (18.3%), and costs (17.6%).
Younger respondents, those with less than a high school education, and those with some college/vocational or technical training were more likely to report not using a preferred method.
The researchers controlled for sociodemographic characteristics and found that people who felt they had enough information to decide which contraceptive was best for them were significantly more likely to use their preferred method (AOR, 3.31; 95% CI, 2.10-5.21). Very confident people (AOR, 9.24; 95% CI, 4.29-19.91) or somewhat confident (AOR, 3.78; 95% CI, 1.76-8.12) could obtain their preferred method and had much higher odds.
Participants who received person-centered contraceptive counseling (AOR, 1.72; 95% CI, 1.33-2.23) or never experienced discrimination in family planning settings (AOR, 1.58; 95% CI, 1.13-2.20) also were more likely to use their preferred method.
“Among current and prospective contraceptive users in the US, one in four are not using a preferred contraceptive method, translating to an estimated 8.1 million people,” Dr. Gómez and colleagues concluded. “This study highlights the need for high-quality information about contraception (particularly important as misinformation and disinformation have been identified as key threats to contraceptive access in the US), as well as the significance of person-centered, non-discriminatory healthcare in reproductive self-determination.”
